Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome—A study based on 3011 patients in China
Introduction
Percutaneous fine needle aspiration (FNA) biopsy for the diagnosis of primary liver cancer (PLC) has recently been actively debated due to the progress of imaging techniques and the risk of malignant seeding after the procedure. During the last decade, advances in imaging techniques have yielded a sensitivity ranging from 89 to 96% in the diagnosis of liver cancer.1, 2 Compared with ultrasound-guided fine-needle (US-FNA) biopsy, imaging methods can eliminate the risk of tumor seeding in the biopsy-needle track and be less limited by invasiveness. However, we should not ignore the risk of false-positive resulted from imaging techniques. In a recent study, 4 of 160 patients (2.5%) underwent unnecessary surgery when their benign lesions were erroneously diagnosed as hepatocellular carcinoma (HCC) by imaging techniques.2 On the other hand, literature suggests that the specificity of FNA for the diagnosis of liver masses is almost 100%, although the sensitivity of FNA ranged from 83.3% to 97.5%.3, 4 The major complications, including hemorrhage and malignant seeding, after FNA biopsies were considered rare.5, 6, 7 However, some resent studies showed implantation metastases can precede other recurrences and shorten the patients’ overall survival.8
China has the highest mortality rate for liver cancer because of the high prevalence of the Hepatitis B virus.9, 10 Recent studies have showed that the incidence of PLC in the US and UK has increased substantially over the last two decades.11, 12 In this study, we will further characterize the usefulness, major complications of US-FNA, such as bleeding and implantation metastases, the influence of this procedure on treatment outcome and patients’ prognosis in this specified population.
Section snippets
Patient characteristics
From June 1985 to May 2005, 3113 patients presented with suspected PLC were treated at Cancer Hospital, Fudan University, Shanghai, China. One hundred two patients were excluded due to loss of follow-up. The remaining 3011 patients, including 2579 men and 432 women, were retrospective reviewed. Patient ages ranged from 10 to 98 years old, with a mean age of 50.1. The sizes of the tumors were ≤3.0 cm in 223 cases, 3.1–5.0 cm in 298 cases, 5.1–8.0 cm in 1119 cases, 8.1–10.0 cm in 747 cases, ≥10.1 cm in
Cases failed for FNA
Of the 3011 patients, 483 cases failed to have biopsies with various reasons. The major reasons were bleeding tendency defined as prothrombase time prolongation >5 s or platelet count <50,000 per ml) which can not be corrected, and poor tumor location, such as near the diaphragm or too close to the surface. Other reasons were shown in Table 1.
Diagnostic outcome
An average number of 2.1 passes were performed per case (range, 1–4 passes). Positive diagnosis of malignancy was achieved in 2061 cases. Cytology results
Operating characteristics of FNA for the diagnosis of liver malignancy
The sensitivities of FNA for detecting malignancy in some recent large research series have ranged from 83.3% to 97.5%, with specificities approaching or achieving 100%.3, 4 The sensitivity and specificity FNA in our study were 91.5% and 100.0% respectively, which compares well with previous studies. However the NPV was only 59.1%, which is lower than those of the other reports.3, 4 This low NPV may partly be explained by the small number of benign patients. Other reasons may result from
Conclusion
Based on this large series study, we conclude that US-FNA biopsy should be valuable for assessing potential liver malignancy and is accurate in the diagnosis of PLC. The risk of bleeding should not be ignored, as it is sometimes fatal, especially in large HCC coexisting superficial location and/or severe cirrhosis. The prognosis does not seem to be influenced by the occurrence of implantation metastases.
Conflict of interest
The authors have no conflict of interest to disclose.
References (24)
- et al.
Ultrasound-guided cutting biopsy for the diagnosis of hepatocellular carcinoma—a study based on 420 patients
J Hepatol
(1996) - et al.
Needle-tract implantation from hepatocellular cancer: is needle biopsy of the liver always necessary?
Liver Transpl
(2000) - et al.
Hepatocellular carcinoma: the role of helical biphasic contrast-enhanced CT versus CT during arterial portography
Radiology
(1997) - et al.
Accurate preoperative evaluation of liver mass lesions without fine-needle biopsy
Hepatology
(1999) - et al.
Imaging-guided and nonimaging-guided fine needle aspiration of liver lesions: experience with 406 patients
J Surg Oncol
(1991) - et al.
Fine-needle aspiration biopsy of the liver: a multicenter study of 602 radiologically guided FNA
Diagn Cytopathol
(2000) - et al.
Risk in fine-needle abdominal biopsy
J Clin Ultrasound
(1983) - et al.
Complications of ultrasonically guided fine-needle abdominal biopsy. Results of a multicenter Italian study and review of the literature. The Cooperative Italian Study Group
Scand J Gastroenterol
(1989) - et al.
Complications after interventional sonography of focal liver lesions: a 22-year single-center experience
J Ultrasound Med
(2003) - et al.
Percutaneous fine-needle aspiration cytology in the diagnosis and management of liver tumours
Br J Surg
(2002)
Cancer statistics, 2006
CA Cancer J Clin
Changes of clinical aspect of PLC in China during the past 30 years—control study for 3,250 cases with PLC
Natl Med J China
Cited by (48)
Vascular invasion and survival after liver transplantation for hepatocellular carcinoma: a study from the European Liver Transplant Registry
2018, HPBCitation Excerpt :Therefore, response to locoregional treatment may, in addition to microvascular invasion, be used to select patients for transplantation.25 Some have suggested the use of preoperative biopsy to obtain the HCC diagnosis.26 In addition, preoperative biopsy may allow for pathological classification of tumor aggressiveness.
When and how should we perform a biopsy for HCC in patients with liver cirrhosis in 2018? A review
2018, Digestive and Liver DiseaseCitation Excerpt :All the above is supported by sound clinical evidence. Wang et al. [16] reported an increase in diagnostic accuracy over the years for biopsy, with an ascertained incidence of seeding of 0.5%, and with seeding-related lesions susceptible to treatment and no impact on patient survival. Fucks et al. [54] did not show any statistically significant difference regarding tumor recurrence between patients undergoing or not FNAB in the pre-operative assessment, confirming the absence of any impact on overall survival of possible seeding even in LT. Takemura et al. [55] and Shuto et al. [56] analysed the outcome of the surgical treatment of peritoneal or thoracic-abdominal implantation after FNAB seeding, showing that when the underlying liver disease is well controlled, surgical removal of the seeding lesions improves the patients outcome, with seeding not exerting any significant impact on patient survival.
Histopathologic Analysis of Transvitreal Fine Needle Aspiration Biopsy Needle Tracts for Uveal Melanoma
2017, American Journal of OphthalmologyHepatocellular Carcinoma: Metastatic Disease
2017, Introduction to Cancer Metastasis